STUDY: DOCTOR DRUG ABUSE ABOUT THE SAME

DURHAM -- Random drug tests for doctors, like those required of many other
workers, might help America's physicians deal with substance abuse, says a
Duke University Medical Center physician studying the issue.

Duke anesthesiologist John Booth made the suggestion after analyzing
results of an anonymous survey sent to anesthesiology department heads at
133 academic medical institutions nationwide. The results were published in
the October issue of the journal Anesthesia and Analgesia.

Booth said the survey indicates that despite the availability of addiction
education and treatment programs and improved controls over operating room
medications, the rate of substance abuse among anesthesiologists has
remained at the same level for the past 30 years.

The survey involved anesthesiologists because those are his peers and
they've been the focus of other inquiries, said Booth. "But there's no
strong scientific evidence showing that anesthesiologists are more prone to
substance abuse than other specialties," he said.

The 26-question survey, returned by all but 10 institutions, included
pre-addressed and -postmarked envelopes to protect respondents' anonymity,
said Booth. It indicated department heads found abuse rates involving
prescription drugs used by anesthesiologists from 1990 through 1997 of 1
percent for anesthesiology faculty members, or 34 out of 3,555.

Another 1.6 percent of the 8,111 residents -- 133 physicians getting their
specialty training in anesthesiology -- were reported to have had substance
abuse problems during the period.

There were no reports of patient harm associated with physician
impairments, said Booth. He said many of the doctors involved probably have
problems with addiction before entering medical school, and continue using
controlled substances while off duty to avoid being caught.

Booth said the numbers reported in the survey might be inaccurate and that
he'd like to look at other medical specialties.

"I'd love it if the National Institutes of Health would fund this research,
because they have a non-biased base," he said. "Maybe as result of this
study we'll get funding. We really need a national database of doctors with
substance abuse problems, because there's no good way of keeping track of
this data. That makes it difficult to judge interventions."

Michael Wilkerson, medical director of the N.C. Physicians Health Program,
said doctors generally parallel the population in overall substance abuse
rates, including alcohol, though physicians tend to abuse prescription
drugs more frequently than the rest of the population because they have
more access to them.

After more than 13 years of providing educational programs and substance
abuse and psychological help to North Carolina doctors who want to maintain
their practices, Wilkerson said he's convinced such programs are helping,
even if they're not reducing abuse rates.

"People are people," he said. "But we're finding that doctors are coming
into the program earlier now. They're being referred by themselves, by
colleagues and spouses who are better able to spot signs of addiction and
who want cures that allow these doctors to keep their licenses."

More doctors now know that if they adhere to rehabilitation programs
prescribed by Wilkerson and his colleague at the state center, psychiatrist
Warren Pendergast, their problem won't be revealed to the state Board of
Medicine for license revocation, he said.

Wilkerson said his organization handled 69 cases in 1993, mostly involving
substance abuse. By last year the program had grown to 116 cases. Overall,
75 percent of the Physicians Health Program cases involve substance abuse
- -- largely alcohol dependence, he said.

Booth said the drug most commonly abused by anesthesiologists is fentanyl,
an intravenous "super" morphine pain medication, typically combined with
other IV liquids to put surgical patients to sleep and relax their muscles.
But fentanyl can become addictive, requiring higher doses over time to
produce the same "high."

Frequently, doctors who are abusing fentanyl will order a little more of
the drug than what's needed for a specific patient, administer a little
less than the full dose during surgery, then steal the unused portion at
the end of the case.

Booth's survey found that 18 percent of substance abusers were discovered
only when they overdosed on fentanyl, which depressed their ability to breathe.

"My gut feeling is that anesthesiologists probably have the same incidence
of abuse as other physicians," said Wilkerson. "But fentanyl is so highly
addictive users will probably bottom out in about six to 12 months."

Duke's anesthesiology department funded Booth's survey. Booth said he
focused on academic institutions because "they're probably the most
regulated of all programs. We felt they're more likely to keep records on
this problem."

The survey found that 47 percent of the institutions responding had
increased the number of hours they provide formal substance abuse
education. Like Duke, Booth said, 63 percent of the programs had tightened
their methods for dispensing, disposing of or accounting for controlled
substances.

Booth said 80 percent of programs compared the amount of controlled
substances dispensed to individual anesthesiologist usage. Only 8 percent
performed random urine testing.

A study from 1970 to 1980 indicated a rate of 0.9 percent for residents and
1.3 percent for faculty. A study from 1975 to 1989 reported a combined 2
percent rate. But direct comparisons are risky, said Booth, because they
were conducted differently.

Joining Booth in preparing the study were Duke colleagues Davida Grossman,
Jill Moore, Catherine Lineberger, James Reynolds, J.G. Reves and David
Sheffield.